Healthcare Provider Details

I. General information

NPI: 1801881438
Provider Name (Legal Business Name): JEAN PAUL GRAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 COATSLAND DR
JACKSON TN
38301-3948
US

IV. Provider business mailing address

244 COATSLAND DR
JACKSON TN
38301-3948
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-4642
  • Fax: 731-422-2277
Mailing address:
  • Phone: 731-422-4642
  • Fax: 731-422-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20854
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: